Category Archives: Post-Traumatic Stress Disorder

Diane Langberg: Living with ongoing trauma


A few years ago, Dr. Diane Langberg gave a talk about ongoing trauma experiences, when there is no “post” in the posttraumatic stress disorder. When there is no after trauma yet (e.g., ongoing domestic violence, living in a war zone, etc.), what kinds of help and hope might a survivor hold on to? Is there anything that can be done?

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What does resilience look like in the face of traumatic experiences?


Does a resilient individual appear as if stress and trauma has not lasting impact? Does it mean we bounce back as if it never happened? Are there better ways to think about resilience in real life?

In 2014 I gave a presentation reviewing the topic of resilience (definition, examples, threats to, and helps) at our annual Trauma Healing Community of Practice hosted by the American Bible Society.

Sometimes we consider only resilience as an individual trait. I spend a bit of time talking about community resilience. Video is 25 minutes and associated slides (not embedded in the video) can be found here: 2014 COP Resilience.

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Diane Langberg on Shame


A few years ago, Dr. Diane Langberg presented on the topic of shame at the 2014 Community of Practice hosted by the American Bible Society. She describes the toxicity of shame as a distinct part of trauma, especially betrayal trauma. You will learn about the cognitive phase of shame, kinds of shame experienced and how the response to shame takes one of 4 common forms (i.e., withdraw, avoid, attack self, attack others).

Make sure you watch to the end as she shares some insights to how God understands and responds to our problem of shame. See how Jesus enters in to our shame.

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Why we need a theology of trauma


[Previously published April 2015 at http://www.biblical.edu. The faculty blog no longer exists there thus re-posting here]

We live in a world shaped by violence and trauma. This week that I write 147 Christian Kenyan university students were killed because of their faith. Such horrific forms of violence shock us. But they shouldn’t given that in our own country violence and trauma are everyday occurrences. While some of our local brothers and sisters face actual death, all of our communities are shaped by soul-crushing abuse and family violence. Take the most conservative numbers we have—1:6 males and 1:4 females have experienced sexual assault before age 18—and realize that a large portion of your friends and acquaintances have traumatic experiences.

In a congregation of 100, 20 of your fellow church members are walking around with invisible wounds of sexual violence on their bodies and souls. And that number says nothing about those walking around with other invisible wounds, such as caused by domestic violence, racial prejudice, sexism, bullying and the like. Were we to include these forms of interpersonal violence the number would likely reach 70!

As my friend Boz Tchividjian asks, what would the sermons and conversations look like if 20 of our mythical congregation of 100 had just lost a house in a fire or a child to premature death? Wouldn’t we be working to build a better understanding of God’s activity in the midst of brokenness rather than passing over pain as a mere hiccup of normal life?

Yet, we continue to imagine trauma as some sort of abnormal state.

Ruard Ganzevoort[1] tells us that, “When one looks at issues like these, we must conclude that our western societies are to no less degree defined by violence and trauma, even if everyday life is in many ways much more comfortable” (p. 13). Thus, Ganzevoort continues, we must “take trauma and violence not as the strange exceptions to an otherwise ‘nice’ world” (ibid, emphasis mine). He concludes that while we have a strong theology for sinners, we have a less articulated theology for victims.

What if we were to read the Bible in such a way to build a theology of trauma for victims? What would it look like? I would suggest that Diane Langberg’s maxim sets the stage quite nicely: the cross is where trauma and God meet. Jesus cries out due to the pain of abandonment by the Father. Since we do have a high priest who understands our trauma (Hebrews 4:15), we can read the entire canon from the frame of trauma—from the trauma of the first sin and death to the trauma of the cross to the trauma just prior to the coming new heavens and earth.

Key Themes in a Theology of Trauma

Reading the Bible through the lens of trauma highlights a few key themes beyond the foundation of a God who Himself knows trauma firsthand in the unjust torture and death of Jesus:

Anguish is the norm and leads most frequently to questions

When more than 40% of the Psalms are laments (and that doesn’t count the primary themes of the prophets!) we must recognize that anguish is most appropriate forms of communication to God and with each other. But we are not alone in the feelings of anguish. God expresses it as well. Notice God expresses his anguish over the idolatry of Israel (Eze 6:9) and Jesus expresses his when lamenting over Israel (Luke 13:34) and cries out in questions when abandoned by the Father (by quoting—fulfilling—Psalm 22).

Despised and rejected, a man of sorrows, acquainted with grief.

Peace happens…in context of chaos

Psalm 23 comes to the lips of many during times of trouble as it expresses peace and rest during times of intense trouble. Shadows of death yet comfort; enemies around yet feasts. Peace happens but rarely outside of chaos and distress. Consider Jeremiah 29:11, frequently quoted to those going through hardship to remind them that God has a plan. He does have one, but recall that the plan was to live in exile among those who see the Israelites as foreigners and second-class citizens!

The kingdom of God in the present does not promise protection of bodies

Try reading Psalm 121 aloud among those who have survived genocide or been raped repeatedly by soldiers. “The Lord will keep you from all harm.” Really? You lost 70 family members? You cannot maintain your bladder continence due to traumatic injury to your bladder? Where was your protection? Our theology of God’s care must take into consideration that He does not eliminate disaster on those he loves. Recall again the trauma wrought on those God chose to be his remnant. They were the ones ripped from families and enslaved by the Babylonians.

God and his people are in the business of trauma prevention, justice, and mercy responses

The kingdom of God is not for those who have pure beliefs. The kingdom of God is for the poor in Spirit, the persecuted, those who provide mercy and those who hunger for justice (Matthew 5). True or pure religion is practiced by those who care for the most vulnerable among us (James 1:27). Jesus himself is the fulfillment of healing as he claims Isaiah 61 as fulfilled in his personhood and mission (Luke 4:18-21). We his people are the hands and feet to carry out that binding up and release from oppression.

Recovery and renewal during and after trauma likely will not eliminate the consequences of violence until the final return of Jesus Christ

Despite our call to heal the broken and free those enslaved, we are given no promise that the consequences of violence are fully removed until the final judgment. Rarely do we expect lost limbs to grow back or traumatic brain injuries to be erased upon recovery from an accident. Yet sometimes we assume that traumatic reactions such as startle responses, flashbacks, or overwhelming panic should evaporate if the person has recovered. A robust theology of trauma recognizes we have no promise of recovery in this life. What we do have is theology of presence. God is with us and will strengthen us guiding us to serve him and participate in his mission to glory.

There is much more to say about a theology of trauma for victims. We can discuss things like theodicy, forgiveness, restorative justice, and reconciliation. But for now, let us be patient with those who are hurting as they represent the norm and not the exception. And may we build a missional theology of trauma, not only for victims, but also for all.

[1] Ganzeboort, R. Ruard (2008). Teaching that Matters: A Course on Trauma and Theology. Journal of Adult Theological Education, 5:1, 8-19.

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Two announcements: A transition and an upcoming trauma healing facilitator training in PHL


Yesterday I posted information about summerbts_0314_l_bts_cnslngtxt_red courses at BTS. I’m really excited about Heather Drew’s course that explores therapeutic activities beyond talking about our struggles. Do check that out! Today, I’m posting about an upcoming trauma healing facilitator training (initial and advanced equipping) being held here in Philadelphia May 1-4, 2017. More on that in a minute.

But first, a change…

For the last 17 years I have been teaching in and leading Biblical Seminary’s counseling programs (now housed in our Graduate School of Counseling). I know I’m very biased, but I think our programs deliver training that transforms—mature counselors who learn how to listen and walk with others through difficult times. Over the years we have been able to develop licensure and ministry-oriented counseling programs as well as the Global Trauma Recovery Institute. This last certificate program enables participants to enter into cultures and communities and support trauma recovery without causing harm.

I’ve enjoyed every minute of it, due in no small part to supportive administration, excellent students, and fantastic staff who every day make BTS look great! But, after months of thinking and praying, I have decided to step away from the leadership of the program and full-time employment at BTS.  Beginning July 1 I will assume the position of Director of Training and logo-thiMentoring with the American Bible Society’s Mission: Trauma Healing. I have been partnering with the Bible Society since 2010 as the Co-Chair of the Advisory Council for ABS trauma healing programs. In this new venture I hope to have a closer role in supporting best practices in their train-the-trainer model of addressing trauma around the world.

If you are wondering why a psychologist would want to work as a trainer of lay and pastoral leaders in a Scripture-engagement trauma healing program, read this: 4 Reasons Why I Promote Scripture-Based Trauma Healing. Short answer? We can’t solve the world’s trauma if we don’t change the culture of conversation about trauma and faith. This program can do that.

Want to join me in equipping others?

May 1-4 ABS will run a local training for both initial and advanced equipping sessions designed to teach you how to lead healing groups and/or run equipping sessions to train others to lead healing groups. I will not be doing most of the training but I do hope to put in an appearance. This document will give you a bit of an overview. This one tells you about the role of the facilitator. And if you are already sold on the material and the mental-health informed training program, here’s where you sign up. Can’t attend now? Check thi.americanbible.org for dates of upcoming trainings here and in other parts of the world.

What is not changing about my role at BTS?

As the Thomas V. Taylor Visiting Professor of Counseling & Psychology, I will continue to teach gtc-logothe Global Trauma Recovery Institute’s curriculum with Dr. Diane Langberg. If you are looking for continuing education and specialization in trauma recovery, this mostly online curriculum may be right for you. In addition, I will provide additional support and teaching for BTS as they need it. However, under the leadership of Bonnie Steich, LPC, NCC, ACS, the existing faculty and staff will continue to deliver an exceptional curriculum.

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Trauma and the Church presentation this Friday night


This weekend, Foundations Christian Counseling is hosting a 2 day conference, Counsel From the Cross at Spruce Lake Retreat. I will be speaking Friday night (8 pm) on “The Cross, the Church, and Trauma: Making the Church a Safe Place for Victims of Trauma.” Use the 2nd link above to register for the day or the weekend.

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Watch live stream presentations on power that harms or heals


Starting Tuesday, The Mission: Trauma Healing ministry of the American Bible Society will livestream its 2017 Community of Practice. You can link up here. Conference begins at 8:30AM EDT.

Here are a few of the notable plenaries

  • Tuesday 11 AM: The Good, Bad, and Ugly of Trauma, By Diane Langberg, with Phil Monroe
  • Wednesday 9 AM: The Exploitation of Power in Cultures, By Sherwood and Judith Lingenfelter
  • Wednesday 3:30 PM: Your Power as Facilitator, By Phil Monroe with Diane Langberg
  • Thursday, 9 AM: How to Empower People who have Lost Their Power, By Michael Lyles, MD
  • Thursday, 11 AM Power in Trauma and Healing in Rwanda, By Baraka Paulette

There are other presentations but these are some of the key presentations on the topic of power. Hope you can make it online.

 

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PTSD: A New Theory? An Old Treatment


Researchers Liberzon and Abelson at the University of Michigan have published an essay articulating a new way of conceptualizing what is happening in the brains of those with Posttraumatic Stress Disorder. While you can’t read their essay for free, you can read this good summary here.

What is their new theory? the neurobiological problem of PTSD is “disrupted context processing.” In simple terms, I fail to respond to the “stimulus” in its proper context when I am triggered by old experiences in a new setting. Even more simply, when I wake up on full alert in the middle of the night after smelling wood-smoke in my sleep I initially fail to recognize the context (my neighbor burns wood) and immediately think my house is on fire (as it once was). Thankfully, the alertness is less than it used to be and I don’t always get up to check on my house.

The authors suggest that 3 separate and current brain models are inadequate in their scope of understanding the brain’s activities in PTSD. From their perspective the “fear model” (Fight/flight learning), the “overactive threat detection model” and the “executive functioning model” work best when integrated into one unified theory with their new label. And, in true humble researcher fashion, they request help in testing this model to see if indeed it can carry the freight.

An Old But Essential Treatment?

It is good to have a better handle on what is happening in the brain when someone experiences PTSD. Neurobiological research is growing by leaps and bounds. It is hard, frankly, to keep up. And yet, let us not forget an old but essential part of PTSD treatment, the person of the therapist. Humans are designed to be in relationship. PTSD has a way of shattering connections with others and thus the treatment must reverse the disconnect. Being present and bearing witness to trauma will always be the first and primary intervention every therapist must learn. Our temptation is that we want to move beyond the bearing witness phase into change phases. While this is understandable (we want others to get better as fast as possible), we sometimes want this for our own reasons–to avoid the pain we experience in sitting with traumatic experiences of others.

Let us remember that we therapists (and pastors, friends, etc.) are the primary intervention when we are present with those who suffer, when we become a student of their suffering. All other treatment activities stem from this foundation. To use a different analogy, consider Dr. Diane Langberg’s meditation, “Translators for God” (Day 26 of In our Lives First). In this meditation she describes the experience of being translated in a seminar. The translator must fully understand both languages in order to accurately communicate the speaker’s words into the heart language of the hearers. Counselors are translators for God and for healing. And yet, if they do not deeply learn the heart language (pain and trauma experience) of the client, they will not be able to connect the client to healing and to the God who heals.

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What is more important to your church when it fails abuse victims? Gospel-driven behavior or reducing liability


Over the years I have had the opportunity to walk with church leaders through the difficult waters of abuse, whether done by leaders or done by congregants. One of the first conversations I try to have with those tasked with responding to the situation is this: What core values do you want to shape your response? Another way of saying this could be, “At the end of the day, who do you want to be, who do you think Christ calls you to be?

These values do not tell you what to do. They do not give you steps. But, they will help evaluate if a particular response is moving towards or away from those values.

If we don’t start at this point, then a couple of other values will control the conversation and control the decision-making: limiting legal liability, damage control, reputation management, and the like. These are understandable but do not comport with Gospel-driven responses to abuse.

Consider this fictional case.

A decade earlier a youth pastor is caught engaging in sexual activity with a teen. The church does not name it at sexual abuse and allows the youth pastor to leave and does not tell the congregation why he left. All this was done for complex reasons: lack of understanding of the gravity of the situation, desires to protect the victim (requested by the parents), and desires to protect their own identity. Years later, it is discovered the youth pastor has gone on to abuse more children in two other settings. Through a variety of reasons, the church is confronted for its failure to handle the situation properly. They are publicly accused of misconduct. The leadership of the church calls their attorney and their insurance company and get the strong advice to not admit any wrongdoing. Instead they are to make a bland statement and initiate an internal investigation (some of the leaders now were not there ten years ago). The report is issued some time later with policy changes made public. While it reveals “mistakes were made” by one of the leaders no longer present, it offers regret but falls short of an apology or indication that the church bore any responsibility for the subsequent abuse experiences.

What core values shaped the church’s response?

What would a church response look like if shaped by deep apology and behavioral repentance? What would it look like if the church considered the plight of the victims and their needs? Would they feel a responsibility to support their recovery? What if they cared more for kingdom values more than worrying whether they would be sued?

Sometimes, times of trouble reveal which god we really serve the most. And sometimes it is not very pretty.

It doesn’t always go badly. I do know a number of churches who opened themselves up to increased liability in order to speak truth about their failures. Take heart. It is possible!

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Reliving memories long after trauma. Why does it happen?


I just returned from a week’s trip to Lebanon to train participants in a Scripture-Engaged mental health-informed trauma healing program. It was a wonderful experience. I made new friends, heard important stories of hardship and God’s faithfulness. I ate good (no, great!) food, and saw some beautiful scenery. Now, as I try to get my body clock back on home time zone, I’m waking early. In those wee hours of the morning, many of these memories come without any seeming effort on my part. There are great ones–laughter, sweet times, a poignant story of pain and heartache, a story of courage–and the brief moments of terror in several taxi rides. Since we survived the taxi rides, these latter memories are no longer negative as much as they invoke a chuckle or two.

In a small way, I’m reliving and recalling memories. I can smell the smells. I can feel the tension of riding in the front seat of a taxi going 60 miles an hour on a city street or the driver’s attempt to squeeze between a barrier and a large truck at a high rate of speed with only inches to spare. I can feel it and see it. And I didn’t even try to recall either the good or the bad. They just appeared.

This is how traumatic memory works. You experience a trauma and later flashes of memory–painful, shocking, unwanted–appear after the subtlest of triggers. You do not merely remember it, you feel it. You taste it, as if it were happening again. They come in bits and pieces, flashes and images; rarely in a linear sequential fashion.

While most good and bad memories fade and are replaced by new and more salient experiences, some memories stay powerfully strong and consistently intrude into the present. Even when we tell ourselves, “We’re safe now. We are no longer in danger” or “You’re not a child anymore, you are grown up and don’t have to be afraid of being hit,” the memories and associated feelings keep coming. It is as if your logic and perceptions aren’t able to moderate the response.

Let me give you a little silly example. I once became violently ill  for 4 days after eating deli turkey. To this day I cringe and feel stomach pain when presented with deli turkey. That experience was more than 12 years ago. Yet still I react. I know that what is in front of me is not tainted but it doesn’t seem to matter to my stomach.  Sure, the reaction I have is minimal and faded compared to immediately after my illness. But it is not gone.

Why does this happen? What are the processes in play that keep us experiencing and reliving what may be old and distant–as if it were still present? What follows is brief and a relatively simplistic summary of two very complex processes. Use them to help you understand yourself or a friend and to increase your empathy for those trapped in such processes.

Memory and the Connected Self

Psychology focuses much of its work on the individual person–the self. However, the self never exists outside of social connections (or disconnections) with others. Our understanding of our self begins at birth with billions of interactions (smiles, frowns, words, touch, etc.) with others. As we develop and become aware of ourselves, we often have key experiences of success or failure that continue to shape our sense of self long into the future. Find someone with a powerful sense of failure and you will find someone who will struggle to interpret present success as indicative of who they are. Whether success or failure oriented, both outlooks form on the basis of how we perceive that others see us. It seems that shame and humiliation act as intensifiers making it hard to alter our sense of self even after corrective experiences. They turn me from “bad things happened to me” into “I am bad.”

Memory and the (dis)Connected Brain

In simplistic language, the brain is an amazingly connected and efficient organ firing constantly day and night. Memories are stored and accessed, intensified or eroded, and often altered through the firing of neurons. The efficient brain “learns” to access information quickly. Just as you no longer have to think to insert your key into a lock the right side up, you also no longer have to consciously recall a memory–it just happens. Because multiple hormones and structures in the brain are involved in memory formation, it stands to reason that ignoring a life-altering memory (and the full-bodied experience of it) is next to impossible. Structures like the brainstem, amygdala, hypothalamus, hippocampus are evaluating and communicating (or not) with high-level processing within the cortex even before you know it. Thus, a memory and its reaction is already well-underway before a person can think and critique such a memory.

So, are we doomed to be controlled by our past?

No. There is ample evidence that we can form new connections and minimize intrusive and unwanted memories. The brain is plastic. It is adaptable and changeable. And yet, we are not in the age of the MiB neuralyzer. God does not usually remove us from our histories or make them so distant they have no effect on us. Adaptation takes time and energy and rarely is so complete that the person no longer feels nothing when they recall a painful event (in fact, feeling nothing might be rather dangerous as it would be a denial of reality).

So, the next time you are beating yourself up for still struggling with the past (or are questioning why a loved one can’t move beyond a trauma), be gentle. Consider instead how you might develop a corrective response that accepts what has happened and gives opportunity for a new second response after the first automatic reaction.

 

 

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